My perfectly dull day

It happens, now and then; not as often as one would wish, but occasionally.   In other professions, a perfect day is when you make that super sale, finish a protracted project, win an important race or craft a special, remarkable piece of art.  An oncology perfect day can be without bells, whistles, pats on the back, nor cash register’s whirr.  Some of the best days lack pizzazz, vibrant emotion or pulsating light.  A perfect day in the cancer clinic is when I am overwhelmingly, exhaustingly, bored.

It started with three breast cancer survivors; long recovered from surgery, radiation, chemotherapy; living full lives, in complete remission. No lumps, burns or pain. We talked about normal labs, normal mammograms and the normal lives of their normal children and families.

Then there was a lymphoma patient, four years off chemotherapy. No cough, fever nor fatigue.  We tried to talk about her plans for spring and the need for a follow up scan, but the constant interruption of her precociously articulate 18-month-old daughter, proved an intense distraction.  Her examination is fine, as best I could tell; the child insisted on sitting on Mommy’s lap, through the whole thing.

Naomi came in, anxious, because a CT scan report was read by her primary doctor as showing a growing thoracic mass.  He told her she might need a biopsy, to talk to me.  The “mass” was scar tissue left by surgery and radiation.  She left smiling.  I returned to my desk, drenched in ennui.

Two Chronic Leukemia patients were in.  Their leukemia’s remain just that, chronic. One is in complete remission on a pill.  He feels completely well.  The other is without any change in her blood count for years.  She feels completely well. No treatment to design, no tests to order, no side effects to explain.

A Stage IV ovarian cancer patient came to see me.  She is 12 years s/p intensive abdominal surgery with infused intra-abdominal chemotherapy.  She remains NED (No Evidence of Disease).  Her physical and labs are benign, including CA125 at the bottom of the range.  She complained about being tired.  Apparently, three grandchildren are visiting and keeping her up late.  I have no therapy for that.

Sue was in.  She carries an unknown cancer gene.  She has survived breast cancer, lymphoma, sarcoma and melanoma.   Sue needed urgent advice regarding which vaccines to take for her trip to India.  I may have slept through that lecture, so I referred her to a travel infectious disease doc.

Joyce, the incredible, dropped by for her annual.  A carrier of the BRCA2 gene, I treated her for breast cancer, 15 years ago.  The amazing thing about her is not that she is alive and healthy.  The incredible thing is that somehow she failed to give the gene to any of her five children.  A 1:32 mortal gamble that saved suffering for each. Still, that is old news.  Joyce was out the door in minutes; I will see her again in 2015.

Renewed Alan’s medical marijuana. It is working, and he is able to eat and rest without nausea. He is looking forward to his grandson’s first birthday party.  His cancer is in control with chemo, which he gets regularly and does not need to be changed.

Nancy was there, because she felt a mass in her upper abdomen. She was concerned her kidney cancer had returned.  There was no evidence of cancer, but I have to admit the xyphoid process of her sternum does stick out a little.  That is normal anatomy and the way she has been since birth.  She left, reassured.

Finally, Mel, status post bone marrow transplant for Multiple Myeloma.  He complained of pain.  Finally, something to evaluate.  Mel twisted his knee skiing through the trees at Stratton.  Moist heat, three times a day, passive and active range of motion, and don’t forget to wear a helmet.

It happens now and then. Not as often as I would wish.  It was a day without new tumors, pains, scary X-ray findings, bad news or terrible fear.  No excitement, life saving intervention or tears.  A day of boredom.  Is there anything more exciting than that?



  • Daniel Oreadi
    I really enjoy reading your posts and realize everyday that id was a great move on my part to subscribe to them. As an Oral and Maxillofacial Surgeon who specializes in head and neck cancer I have to say that dull days probably occur more often in my practice than yours but they are welcomed with a smile at the end of the day. Great post!!
    • James Salwitz, MD
      Thanks very much. You have a really tough job, so I am happy if I can help, even a little. jcs
  • I love your posts. Thank you for being so consistent with them as they are always something to look forward to and think about long after I have read them.
    • James Salwitz, MD
      Thank you so much for following my ramblings. jcs
  • NKim
    Thanks Dr. I enjoy every posts. They re-conciliate us with the medical world. From a TN inflammatory breast cancer, 1 weeks from having adjuvant chemo, mx, radio, NED from now on.
    • James Salwitz, MD
      That is a great compliment. I believe the more we understand each other, the better care all will receive. jcs
  • Liz
    Glad you had a boring day. I, and every cancer patient you have I am sure, wish you more of them LOL
    • James Salwitz, MD
      From your lips…. jcs
  • NKim
    excuse my poor English: I am 1 week post treatment!
    • James Salwitz, MD
      You are doing fine. Hang in there. It gets much better. jcs
  • My closest friend, whose oldest friend Dee, who died recently, was your patient, told me about your blog. My husband had colon cancer surgery at MSKCC this past May, followed by chemotherapy. In April he'll have his follow-up colonoscopy and in May his scan. Your writing has been a great source of interest and often comfort to me. He and I don't talk a lot about his cancer but when I read your posts I feel as if I am on the listening end of a wonderful conversation. Thanks so much for what you do. (Dare I say I wish you were his doctor, though he has a good one--just not the best communicator?)
    • James Salwitz, MD
      I am glad that your husband is doing well and that I am able to help a little. In April it will be warm, blooming and with the smallest bit of luck, your husband will have a clean bill-of-health. jcs
  • Thank you for this. I've read so many "get that and you're dead" opinions in articles on the web since I started research for my patient blog. I suspect you're doing something right! MLF
  • Ray
    My wife passed away 3 weeks ago after a four years of visits to your office. The last weeks were difficult to say the least but the care and concern you gave Dee was a great source of help for both of use. These days I try to keep busy and focus on the future but I find this difficult. Strangely I miss our visits. Often we arrived with so many questions and you patiently sat with us and always called it the way it was, sometime good news sometimes not. Thank you for being there when we needed you most.
    • James Salwitz, MD
      You and your wife shared a very special relationship, drawing strength and joy from each other, moment by moment. For me time spent with you and her was a learning and nurturing experience. "Strangly," I too took miss our visits. Until our next meeting, jcs
  • This is by far the most reassuring post you have ever written (since I've been reading).
    • James Salwitz, MD
      Thank you. These are the moments which can get all of us through. jcs
  • This post makes me realize not to take a "dull" healthy day for granted. Thanks for the reminder.
  • Bridget
    So now I understand why both my oncologists smile so broadly and happily when I make my annual visits! I have thought I must be a complete waste of their time since my remissions continue without any events or issues. But maybe I am one patient on their schedules on those days who represents a good outcome, and that makes them happy. Your perspective has broadened mine, and that's something you so do well in all your writing.

Leave a Reply